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See a sample rate comparisonCPT 53425 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Surgical Repair Of Urine Tract, Surgery To Open A Blockage Repair An Injury Or Correct A Prolapse (Bladder Slips Out Of Place). The Procedure Is Performed In Two Stages.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Urinary System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None 22 - Increased Procedural Services 80 - Assistant surgeon |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 53425 |
| Medicaid Fee Schedule | View Medicaid rates for 53425 |
National average reimbursement for CPT 53425 by major payers:
$1,181.16
$1,264.31
$1,299.63
$1,528.33
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CPT 53425
5 of 25 sample ratesHigher to lower in this preview
Virginia Mason Medical Center, Virginia Mason Issaquah Asc
Virginia Mason Medical Center
$6,399.00Published rateAmber Meadows Surgery Center LLC
$3,500.00Published rateUoi East Bay Surgery Center LLC
$2,492.00Published rateIndiana Vascular Surgery Center LLC
$1,617.00Published rateBrown Medicine, Brown Medicine Endoscopy Center
Brown Medicine
$700.00Published rate
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See a sample payer proposalCPT 53425 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 53425 code is part of the Surgery services used for Surgical Procedures on the Urinary System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 53425 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 53425-CPT | High | Surgical Repair Of Urine Tract, Surgery To Open A Blockage Repair An Injury Or Correct A Prolapse (Bladder Slips Out Of Place). The Procedure Is Performed In Two Stages. |
| 53430-CPT | High | Urethroplas,Reconst.Female Urethra |
| 53431-CPT | High | Reconstruct Urethra Bladder, Urethroplasty With Tubularization Of Posterior Urethra And Or Lower Bladder For Incontinence Eg Tenago Leadbetter Procedure |
| 53450-CPT | Moderate | Repair Opening To Urine Tract, Surgery To Widen Or Reconstruct The Meatus (Opening To The Urinary Tract) To Enhance Urine Flow. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 53425. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 53425 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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